Neurological deficits

• Consider additional diagnostics (including MRI cerebrum or myeloma) depending on the situation and condition of the child.

 DO

• Pay attention to the child's approach.

• Consider an eye patch or taping a lens.

 DO

• Use methyl cellulose eye drops during the day.
• For sleeping, use oculentum simplex ointment and a watch glass plaster.

• If redness of the eye occurs, consider more frequent drops and/or ointments, both with or without antibiotics.

 DO

• Advise children to close their eyes briefly and then open them again.
• Provide good room lighting; this may reduce the likelihood of visual hallucinations developing.

• Consider referral to a vision expertise centre to get targeted advice for how to deal with the visual problems.

 DO

• Make it known that you are present by touching or looking at the child.
• Talk quietly and clearly.
• Avoid excessive ambient noise.
• Use visual support through text, pictures or gestures.

• Consider hearing aids or solo aids depending on the child's condition.
• Consider referral to an expertise centre on hearing problems to obtain practical advice on managing the hearing problems.

 DO

• Provide optimal nutrition in terms of consistency; consider thickening beverages.
• Offer drinking with a straw or from an appropriate drinking cup.
• Provide breaks between sips to prevent choking.
• Monitor administration of medication and adjust the form of administration as needed.

• Consider involving a speech therapist or occupational therapist for swallowing advice.
• To prevent aspiration or for adequate intake, consider a feeding tube.

 DO

• Be alert to changes in communication abilities.
• Make best use of support in communication.

• Consider guidance from a speech therapist (possibly along with an occupational therapist) for advice on supportive communication devices appropriate to the child's abilities.

• Consider guidance from a (paediatric) physical therapist, occupational therapist, paediatric neurologist and/or paediatric rehabilitation physician.

 DO

• Be alert for spinal cord injury or other neurological symptoms in cases of urinary retention.

• Consider placement of an indwelling catheter or intermittent catheterization.

 DO

• Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.